Placebo Effect

Like most of us at some time or another, you may have had a healthy scepticism about the use of placebos.

Here is an approach you may like to consider, to help you benefit from the mysterious healing powers of the placebo, even when you know it is a placebo you are taking; an approach that has been useful for a growing number of people in recent times, recommended by a homeopath of some 30 years experience.

Consider this . . . undoubtedly, there is a greater chance of success if the placebo taker believes it can work, and even more if the placebo taker trusts and has faith in the prescriber (which paradoxically can be themselves).

The simple mathematics around the mysterious healing powers of the placebo reveals an improvement in at least 30% (and up to 70%) of cases. You can be one of the 30-70%.

Our aim at universal Placebos is to help you shift from curiosity to action – to dare to try something new.

What would convince you to use a placebo? If you are curious you could try this simple procedure to evoke the positive qualities of Acceptance, Gratitude, Faith, Trust and Action.

Twice a day, say morning and night, take 3 placebo pilules.

With the first pilule focus on acceptance of who you are and where you are, all your advantages and disadvantages, strengths and weaknesses. Accept your true situation, so you are free to respond, and not just react.

As you take the second pilule focus on gratitude. Be thankful for all the positives you have in your life . . . “it could always be worse.” Be mindful of where you want to be. Have faith you will find inner guidance. . . just trust it, that these inner revelations are right and correct.

As you take the third pilule, just say YES . . . it feels better. Smile and go . . .take action with the first step, whatever that is . . . and believe it is possible.

Or, why not create your own ritual? Here are some tips:

(a) Apply KISS tactics (keep it simple sweetheart)
(b) Choose easy times to take placebos, like when you have a cuppa
(c) Take it at least twice a day, morning and night
(d) Be mindful and present in the moment
(e) Keep it short and easy to complete

The ultimate truth is that the successful outcome of any healing situation is determined by the actions and choices and healing system of the individual, regardless of the healing modality. Nobody can make anyone else better, but everyone needs some help sometime.

The truth is that the successful outcome of any healing situation is determined by the actions and choices and healing system of the individual, regardless of the healing modality. Nobody can make anyone else better, but everyone needs some help sometimes.

Why Placebos Work Wonders

From Weight Loss To Fertility, New Legitimacy For ‘Fake’ Treatments

By SHIRLEY S. WANG

Say “placebo effect” and most people think of the boost they may get from a sugar pill simply because they believe it will work. But more and more research suggests there is more than a fleeting boost to be gained from placebos.

A particular mind-set or belief about one’s body or health may lead to improvements in disease symptoms as well as changes in appetite, brain chemicals and even vision, several recent studies have found, highlighting how fundamentally the mind and body are connected.

Is the placebo effect just the boost you may get from a sugar pill simply because you believe it will work? New research suggests there is more than just that to be gained from placebos. Emily Nelson reports. (Photo: Getty Images)

It doesn’t seem to matter whether people know they are getting a placebo and not a “real” treatment. One study demonstrated a strong placebo effect in subjects who were told they were getting a sugar pill with no active ingredient.

Douglas B. Jones

Placebo treatments are sometimes used in some clinical practices. In a 2008 survey of nearly 700 internists and rheumatologists published in the British Medical Journal, about half said they prescribe placebos on a regular basis. The most popular were over-the-counter painkillers and vitamins. Very few physicians said they relied on sugar pills or saline injections. The American Medical Association says a placebo can’t be given simply to soothe a difficult patient, and it can be used only if the patient is informed of and agrees to its use.

Researchers want to know more about how the placebo effect works, and how to increase and decrease it. A more powerful, longer-lasting placebo effect might be helpful in treating health conditions related to weight and metabolism.

Hotel-room attendants who were told they were getting a good workout at their jobs showed a significant decrease in weight, blood pressure and body fat after four weeks, in a study published in Psychological Science in 2007 and conducted by Alia Crum, a Yale graduate student, and Ellen Langer, a professor in the psychology department at Harvard. Employees who did the same work but weren’t told about exercise showed no change in weight. Neither group reported changes in physical activity or diet.

Douglas B. JonesPatients in a recent study were treated with placebos for an induced asthma attack. They reported feeling just as good as when they received an active treatment with albuterol.

Another study, published last year in the journal Health Psychology, shows how mind-set can affect an individual’s appetite and production of a gut peptide called ghrelin (GREL-in), which is involved in the feeling of satisfaction after eating. Ghrelin levels are supposed to rise when the body needs food and fall proportionally as calories are consumed, telling the brain the body is no longer hungry and doesn’t need to search out more food.

Yet the data show ghrelin levels depended on how many calories participants were told they were consuming, not how many they actually consumed. When told a milkshake they were about to drink had 620 calories and was “indulgent,” the participants’ ghrelin levels fell more—the brain perceived it was satisfied more quickly—than when they were told the shake had 120 calories and was “sensible.”

The results may offer a physiological explanation of why eating diet foods can feel so unsatisfying, says Ms. Crum, first author on the study. “That mind-set of dieting is telling the body you’re not getting enough.”

Studies across medical conditions including depression, migraines and Parkinson’s disease have found that supposedly inert treatments, like sugar pills, sham surgery and sham acupuncture, can yield striking effects. A 2001 study published in Science found that placebo was effective at improving Parkinson’s disease symptoms at a magnitude similar to real medication. The placebo actually induced the brain to produce greater amounts of dopamine, the neurotransmitter known to be useful in treating the disease.

At times, a weaker placebo effect might be desired. In trials of experimental drug treatments for dementia, depression and other cognitive or psychiatric conditions, where one patient group takes medication and the other takes a sugar pill, it can be difficult to demonstrate that the medicine works because the placebo effect is so strong.

With depression, an estimated 30% to 45% of patients—or even more, in some studies—will respond to a placebo, according to a review published in December in Clinical Therapeutics. An additional 5% of patients were helped by an antidepressant in cases of mild depression, and an additional 16% in cases of severe depression. (The clinically meaningful cutoff for additional benefit was 11%.)

Fertility rates have been found to improve in women getting a placebo, perhaps because they experience a decrease in stress. A recent randomized trial of women with polycystic ovarian syndrome found that 15%, or 5 of 33, got pregnant while taking placebo over a six-month period, compared with 22%, or 7 of 32, who got the drug—a statistically insignificant difference. Other studies have demonstrated pregnancy rates as high as 40% in placebo groups.

Ted Kaptchuk, director of Harvard’s Program in Placebo Studies and the Therapeutic Encounter, and colleagues demonstrated that deception isn’t necessary for the placebo effect to work. Eighty patients with irritable bowel syndrome, a chronic gastrointestinal disorder, were assigned either a placebo or no treatment. Patients in the placebo group got pills described to them as being made with an inert substance and showing in studies to improve symptoms via “mind-body self-healing processes.” Participants were told they didn’t have to believe in the placebo effect but should take the pills anyway, Dr. Kaptchuk says. After three weeks, placebo-group patients reported feelings of relief, significant reduction in some symptoms and some improvement in quality of life.

Why did the placebo work—even after patients were told they weren’t getting real medicine? Expectations play a role, Dr. Kaptchuk says. Even more likely is that patients were conditioned to a positive environment, and the innovative approach and daily ritual of taking the pill created an openness to change, he says.

Do placebos work on the actual condition, or on patients’ perception of their symptoms? In a study published last year in the New England Journal of Medicine, Dr. Kaptchuk’s team rotated 46 asthma patients through each of four types of treatment: no treatment at all, an albuterol inhaler, a placebo inhaler and sham acupuncture. As each participant got each treatment, researchers induced an asthma attack and measured the participant’s lung function and perception of symptoms. The albuterol improved measured lung function compared with placebo. But the patients reported feeling just as good whether getting placebo or the active treatment.

“Right now, I think evidence is that placebo changes not the underlying biology of an illness, but the way a person experiences or reacts to an illness,” Dr. Kaptchuk says.

Placebo can be more effective than the intended treatment. In a trial published in the journal Menopause in 2007, 103 women who had menopausal hot flashes got either five weeks of real acupuncture, or five weeks of sham acupuncture, where needles weren’t placed in accepted therapeutic positions. A week after treatments ended, only some 60% of participants in both groups reported hot flashes—a robust immediate placebo effect. Seven weeks post-treatment, though, 55% of patients in the sham acupuncture group reported hot flashes, compared with 73% in the real acupuncture group.

Corrections & Amplifications
An earlier version of this article said that a study in the journal Health Psychology about appetite and the gut peptide ghrelin was published earlier this year.

HEALTH
Author equates alternative treatments with placebo effect
Millions of patients seek treatment with unorthodox, unproven therapies, and many find relief.
By SUSAN J. LANDERS, amednews staff. May 12, 2008.
Washington — Doctors may not realize it, but they are familiar with the reason for the apparent success of alternative and complementary treatments; they just call it the placebo effect, said R. Barker Bausell, PhD, a biostatistician and professor at the University of Maryland School of Nursing.
Dr. Bausell, author of the book, Snake Oil Science: The Truth About Complementary and Alternative Medicine, which was released last year to favorable reviews, searched for the scientific evidence to support the claimed benefits of various unconventional treatments. But he came up short.
He conveyed those findings as well as his concern about the increasing amounts of research dollars being directed toward these treatments at an April 23 Capitol Hill briefing held by the Congressional Biomedical Research Caucus in Washington, D.C.
Dr. Bausell also served as research director for the University of Maryland’s alternative medicine center but has left that post for reasons that had nothing to do with his research findings, he said.
Dr. Bausell defined alternative medicines as any of a host of techniques, such as acupuncture, herbs, or yoga for pain management, used to cure a medical condition.
He is concerned that such treatments have moved from the far reaches of healing, where they were practiced by a few believers, to the heart of mainstream medicine, where they are incorporated with traditional treatments in “integrative medicine” centers at elite medical schools and hospitals. The National Institutes of Health’s National Center for Complementary and Alternative Medicine now has an annual budget of more than $121 million.
“Doctors no longer feel comfortable saying these therapies are shams,” Dr. Bausell said.
Many physicians are major players in integrative medicine centers. For example, Harvey Zarren, MD, a cardiologist and president of the board of the Integrative Medicine Alliance, a group of physicians and others in the Boston area, taps into many alternative techniques, including hypnosis, to help his patients lower their blood pressure. There is good evidence that such treatments work, he said. “Why not use all appropriate tools.”
One technique employed by therapists who use complementary and alternative techniques — but one that runs short for conventional medicine — is time, he said. “Give people time, give people respect. Look at the whole person.”
But questions remain about how and why these approaches work, and the need for more study exists.
NCCAM Director Josephine P. Briggs, MD, acknowledged recently in congressional testimony that, although millions of people use alternative treatments, very little is known about the potential of such treatments to improve health and well-being or preempt disease. “We also need to understand how [these] practices interact with other therapies and whether they are safe.”
Figuring out the “why”
But Dr. Bausell sees the central question differently.
Getting at the heart of why so many people believe in the benefit of these techniques means puzzling through “a family of artifacts, both psychological and biological, that conspire to confound us and make fools of us all,” he said.
Everyone makes inferences. A patient seeking relief from pain in an arthritic knee may go to a primary care physician, a rheumatologist and a homeopath and also turn to herbs, megavitamins, prayer and acupuncture, he said. But if the pain subsides while they are involved in acupuncture, “you will never convince that person [it] didn’t heal them.” What is not considered when weighing that success, though, is the waxing and waning nature of such pain, Dr. Bausell said. The easing may have occurred even without an intervention.
Therapists who practice these techniques also fail to keep records, and patients may, out of politeness, say they feel better after treatment even if they don’t, he added.
1 of 2 3/28/12 5:00 PM
Author equates alternative treatments with placebo effect – am… 3/28/12 5:00 PM http://www.ama-assn.org/amednews/2008/05/12/hlsb0512.htm
The placebo effect — defined as a pharmaceutically inactive substance or procedure that can have a therapeutic effect if administered to a patient who believes he or she is receiving an effective treatment — also enters the picture. Dr. Bausell believes the placebo effect has convinced patients a treatment actually works, even when unsupported by research.
The AMA favors the evaluation of alternative treatments using well-designed studies and urges physicians to ask patients routinely whether they use any of these therapies.

Alternative medicine

Think yourself better

Alternative medical treatments rarely work. But the placebo effect they induce sometimes does

May 19th 2011 | from the print edition

ON MAY 29th Edzard Ernst, the world’s first professor of complementary medicine, will step down after 18 years in his post at the Peninsula Medical School, in south-west England. Despite his job title (and the initial hopes of some purveyors of non-mainstream treatments), Dr Ernst is no breathless promoter of snake oil. Instead, he and his research group have pioneered the rigorous study of everything from acupuncture and crystal healing to Reiki channelling and herbal remedies.

Alternative medicine is big business. Since it is largely unregulated, reliable statistics are hard to come by. The market in Britain alone, however, is believed to be worth around £210m ($340m), with one in five adults thought to be consumers, and some treatments (particularly homeopathy) available from the National Health Service. Around the world, according to an estimate made in 2008, the industry’s value is about $60 billion.

Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies. (Meta-analysis is a statistical technique for extracting information from lots of small trials that are not, by themselves, statistically reliable.) His findings are stark. According to his “Guide to Complementary and Alternative Medicine”, around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically indistinguishable from placebo treatments. In only 5% of cases was there either a clear benefit above and beyond a placebo (there is, for instance, evidence suggesting that St John’s Wort, a herbal remedy, can help with mild depression), or even just a hint that something interesting was happening to suggest that further research might be warranted.

It was, at times, a lonely experience. Money was hard to come by. Practitioners of alternative medicine became increasingly reluctant to co-operate as the negative results piled up (a row in 2005 with an alternative-medicine lobby group founded by Prince Charles did not help), while traditional medical-research bodies saw investigations into things like Ayurvedic healing as a waste of time.

Yet Dr Ernst believes his work helps address a serious public-health problem. He points out that conventional medicines must be shown to be both safe and efficacious before they can be licensed for sale. That is rarely true of alternative treatments, which rely on a mixture of appeals to tradition and to the “natural” wholesomeness of their products to reassure consumers. That explains why, for instance, some homeopaths can market treatments for malaria, despite a lack of evidence to suggest that such treatments work, or why some chiropractors can claim to cure infertility.

Despite this lack of evidence, and despite the possibility that some alternative practitioners may be harming their patients (either directly, or by convincing them to forgo more conventional treatments for their ailments), Dr Ernst also believes there is something that conventional doctors can usefully learn from the chiropractors, homeopaths and Ascended Masters. This is the therapeutic value of the placebo effect, one of the strangest and slipperiest phenomena in medicine.

Mind and body

A placebo is a sham medical treatment—a pharmacologically inert sugar pill, perhaps, or a piece of pretend surgery. Its main scientific use at the moment is in clinical trials as a baseline for comparison with another treatment. But just because the medicine is not real does not mean it doesn’t work. That is precisely the point of using it in trials: researchers have known for years that comparing treatment against no treatment at all will give a misleading result.

Giving pretend painkillers, for instance, can reduce the amount of pain a patient experiences. A study carried out in 2002 suggested that fake surgery for arthritis in the knee provides similar benefits to the real thing. And the effects can be harmful as well as helpful. Patients taking fake opiates after having been prescribed the real thing may experience the shallow breathing that is a side-effect of the real drugs.

Besides being benchmarks, placebos are a topic of research in their own right. On May 16th the Royal Society, the world’s oldest scientific academy, published a volume of its Philosophical Transactions devoted to the field.

One conclusion emerging from the research, says Irving Kirsch, a professor at Harvard Medical School who wrote the preface to the volume, is that the effect is strongest for those disorders that are predominantly mental and subjective, a conclusion backed by a meta-analysis of placebo studies that was carried out in 2010 by researchers at the Cochrane Collaboration, an organisation that reviews evidence for medical treatments. In the case of depression, says Dr Kirsch, giving patients placebo pills can produce very nearly the same effect as dosing them with the latest antidepressant medicines.

Pain is another nerve-related symptom susceptible to treatment by placebo. Here, patients’ expectations influence the potency of the effect. Telling someone that you are giving him morphine provides more pain relief than saying you are dosing him with aspirin—even when both pills actually contain nothing more than sugar. Neuro-imaging shows that this deception stimulates the production of naturally occurring painkilling chemicals in the brain. A paper in Philosophical Transactions by Karin Meissner of Ludwig-Maximilians University in Munich concludes that placebo treatments are also able to affect the autonomic nervous system, which controls unconscious functions such as heartbeat, blood pressure, digestion and the like. Drama is important, too. Placebo injections are more effective than placebo pills, and neither is as potent as sham surgery. And the more positive a doctor is when telling a patient about the placebo he is prescribing, the more likely it is to do that patient good.

Despite the power of placebos, many conventional doctors are leery of prescribing them. They worry that to do so is to deceive their patients. Yet perhaps the most fascinating results in placebo research—most recently examined by Ted Kaptchuk and his colleagues at Harvard Medical School, in the context of irritable-bowel syndrome—is that the effect may persist even if patients are told that they are getting placebo treatments.

Unlike their conventional counterparts, practitioners of alternative medicine often excel at harnessing the placebo effect, says Dr Ernst. They offer long, relaxed consultations with their customers (exactly the sort of “good bedside manner” that harried modern doctors struggle to provide). And they believe passionately in their treatments, which are often delivered with great and reassuring ceremony. That alone can be enough to do good, even though the magnets, crystals and ultra-dilute solutions applied to the patients are, by themselves, completely useless.